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Empowering families to make informed choices on co-sleeping with babies

The National Institute for Health and Care Excellence (NICE) updates guidance to clarify the association between co-sleeping and Sudden Infant Death Syndrome (SIDS).

More than 200 babies in England and Wales die unexpectedly in their sleep every year.

There have been long-standing doubts over whether co-sleeping - parents or carers falling asleep with their baby on a bed, sofa or chair - is completely safe.

Updated guidance from the National Institute for Health and Care Excellence (NICE) clarifies the association between co-sleeping and Sudden Infant Death Syndrome (SIDS) to help parents understand the potential risks.

Parents or carers with a child under the age of 1 should be told about the factors associated with co-sleeping (falling asleep with your baby in a bed, or on a sofa or chair) and Sudden Infant Death Syndrome (SIDS) to allow them to weigh up the possible risks and benefits and decide on sleeping arrangements that best fit their family.

Hundreds of babies in England and Wales die unexpectedly in their sleep every year[1]. This is known as SIDS. Little is known about why it happens, but research suggests that co-sleeping combined with other factors may play a part in some way.

Professor Mark Baker, Director of the NICE Centre for Clinical Practice, said the updated guidance is important to consider alongside other safe sleeping advice: “For many years, the Department of Health has advised that the safest way for a baby to sleep is on its back, in its own cot or moses basket in the parents’ room for the first 6 months. This advice had, and continues to have, a significant effect on reducing baby deaths.

“Sadly though, there remain a small number of babies who will die unexpectedly for no apparent reason.

“We don’t know what causes these babies to die suddenly, but we do know that if a parent smokes, drinks alcohol or takes drugs then Sudden Infant Death Syndrome is potentially more likely to occur if they then co-sleep with their infant. There also appears to be an association between co-sleeping and SIDS if the child was born prematurely or with a low birthweight.”

Susan Bewley, a professor of complex obstetrics at King’s College London who chaired the committee which developed the updated guidance for NICE, added: “Parents have the right to know about the association between SIDS and co-sleeping, It will help them weigh up the possible risks and benefits so that they can make a decision that is right for them.”

The updated NICE guidance acknowledges that co-sleeping can be intentional or non-intentional. It advises midwives, health visitors and GPs to recognise this and discuss the issue with parents.

Elaine McInnes, a practice teacher of health visiting and professional development officer from the Institute of Health Visiting, helped to develop the new NICE co-sleeping recommendations. She said: “Being a new parent is exhausting. We know that many new mothers and fathers will, at some point or another, fall asleep with their newborn and parents should not feel guilty or embarrassed. Sharing a bed with your baby at night can aid breastfeeding and in some cultures, co-sleeping is seen as perfectly normal. However, the Department of Health advises that the safest place for a baby to sleep is in a cot, and if that cot is beside the bed it need not interfere with breast feeding.

”The conversation about co-sleeping and the factors that may make SIDS more likely should begin before the baby is even born and discussed at every visit, up until the child reaches its first birthday.

“It’s important that parents are given the most current evidence-based information as far as possible, are comfortable and happy in the decision they make with regard to sleeping arrangements and are supported in making the safest choices for sleeping arrangements.”

The updated recommendations – which cover the first 12 months of a child’s life[2] – also say that healthcare professionals such as midwives, health visitors. GPs and others should:

Inform parents and carers that the association between co-sleeping and SIDS is likely to be greater when they, or their partner, smoke.

Inform parents and carers that the association between co-sleeping and SIDS may be greater with:

parental or carer recent alcohol consumption, or

parental or carer drug use, or

low birthweight or premature infants.

Gabrielle Osrin, a bereaved parent who helped NICE to develop the updated recommendations, said: “Since my daughter died unexpectedly as a baby, I have learnt a lot about SIDS. But, having this information shouldn’t be a privilege.

“It is every parents right to know - whatever their personal circumstance or beliefs – the factors that may make SIDS more likely for their precious baby. If we have this information, I think it would be negligent to not include it in pre- and post-natal advice.”

Francine Bates OBE, Chief Executive of The Lullaby Trust, welcomed the updated guidance: “The Lullaby Trust works with families whose lives have been devastated by the sudden and unexplained death of a baby. The new guidelines from NICE will help professionals have conversations with families both before and after the birth of their new baby.

“We want all health care professionals to be fully informed of the association between co-sleeping and SIDS. Parents hugely value and trust the information and support they receive from GPs, Midwives and Health Visitors. All of us should be working together to give clear messages to new parents empowering them to make decisions which are in the best interest of their baby. “

The updated NICE guidance comes after the Department of Health asked the institute to review its recommendations last year in light of new research. These recommendations replace some, but not all parts of NICE’s 2006 postnatal care guidance.

Ends

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

The postnatal care guidance covers the core care of women and their babies during the first 6-8 weeks after birth. However, the decision was taken to extend this age range up to one-year-old specifically for the recommendations on sleeping with your baby in a bed, or on an armchair or sofa. This was to allow the committee to consider all available evidence on this issue.

About the guidance

The NICE recommendations on the association between co-sleeping (sleeping with an infant in a bed or on a sofa or armchair) and Sudden Infant Death Syndrome (SIDS) are available at http://www.nice.org.uk/guidance/CG37.

The NICE quality standard on postnatal care (published 2013) outlines the need for safer infant sleeping to be discussed with women, their partner or the main carer. Its inclusion in the quality standard highlights it as a key area of care in need of improvement.

The guidance applies to the NHS in England and Wales.

Facts and Figures

Unexplained infant deaths accounted for 8% of all infant deaths occurring in 2012.

8 out of 10 unexplained infant deaths occurred between 28 days and 1 year after birth.

In 2012, almost two-thirds (64%) of unexplained infant deaths were boys

The rate of unexplained infant death was three times higher among low birthweight babies (less than 2,500g) than babies with a normal birthweight (2,500g and over).

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

“Parents have the right to know about the association between SIDS and co-sleeping, It will help them weigh up the possible risks and benefits so that they can make a decision that is right for them.”

Susan Bewley, Professor of Complex Obstetrics at King's College London

"Parents hugely value and trust the information and support they receive from GPs, Midwives and Health Visitors. All of us should be working together to give clear messages to new parents empowering them to make decisions which are in the best interest of their baby."

Francine Bates OBE, chief executive, The Lullaby Trust

“It is every parents right to know - whatever their personal circumstance or beliefs – the factors that may make SIDS more likely for their precious baby. If we have this information, I think it would be negligent to not include it in pre- and post-natal advice.”